HomeMy WebLinkAboutPACIFIC ST 410 02/23/2017CITY OF TUSTIN
'• Community Development Department— Building Division
r 300 Centennial Way, Tustin CA 92780
Building Counter (714) 573-3131— Inspection Recorder (714) 573-3141
BUILDING PERMIT NUMBER: C2017-0072 ADDRESS: 410 PACIFIC ST TUST SUITE
ASSESSOR'S PARCEL NUMBER: 401-J71-03 SUITE NUMBER..:
LOT NUMBER............ .................... : TRACT NUMBER.:
DEVELOPMENT AREA ...............: TUSTIN ISSUED BY.............:
DATE ISSUED.......: 02/23/2017
PROPERTY OWNER ......................: SBEEHAN MICHAEL W TRUST
1842 GALAXY DR
NEWPORT BEACH CA
CONTRACTOR ARCHPITCT
BRIAN FOX CONSTRUCTION
1142 DEBORAH DR
TUSTIN CA 92780
714-801-9421
JOB DESCRIPTION: TO PERMIT TANKLESS WATER HEATER AND ELEC OUTLET
LICENSED CONTRACTOR DECLARATION
"iffflIF
FEB 2 3 2017
CITY OF TUSTIPi
CASHIER
$0.00
$35.89
$0.00
$0.00
$0.00
$0.00
I hereby affirm that I am a licensed Contractor under the provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code, and my license
LICENSE NUMBER: 874670 LICENSE CLASS: B
Expires DATE:03/31/2018
OWNER BUILDER DEC.) ARATION:
I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business Professions Code: Any City or county which requires a perm
structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License L:
3 of the Business & Professions code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant'for a permit su
hundred dollars (S500-00)-
1 as owner of the property, or my employees withwages as thein sole compensation, will do the work and the stmcturc is not intended or offered for sale (Section 7044, Busi
not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvemem
building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purposes of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business & Professions Coda The Contractor's Lice
or improves Theron, and who contracts for such projects witha contractor(s) license pursuant to the Contractor's License Law).
I der Section Business & Professions Code for the following mason(s):
Owner Si tore: Date:
WORKERS' 'OMI'ENSATJON DECLARATION:
I hereby of rou under penalty of perjury one of the following declarations:
I have and will maintain a certificate of concent to self -insure for Workefs Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the w(
I have and will maintain Worker's Compensation insurance, ac required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
Number we,
POLICY NUMBER: 1.846083 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the erformance of the rk whicy this permit is issued, I shall not employ any person in any maturer so as to become subject to the Worker's Compensal
subject to [hc�7oikerIrgpylfsatio� r .. ro f � 'on1700 of the Labor Code, I shall forthwith comply with those provisions.
WARNING: FaiWn to secure Worker's Compensation coverage is unlawfid, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ('
as provided for in Section (3 700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby nude to the Building Official for a permit subject to the conditions and restrictions set forthon this application. Each person upon whose behalf this applicatir
benefit work is performed under or pursuant to any permit issues as a result of this application agrees to, and shall, indemnify and hold harriless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I agree not to occupy or allow occupancy of any building authorized by this permit until foal inspection has been received. I certify
information is correct. I agree to comply with all City and State laws relating to the building construction, and hereby authorize representative of the City to enter upon the above m
1"
-**BUII,DING PERMITS ARE SUBJECT TO EXPIRATION IF WORK IS NOT COMMENCED -WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS'*-
O.C.F.A. Number.........:
-
OCCUPANT LOAD:
0
OCCUPANCY GROUP:
CONSTRUCTION TYPE.:
RESIDENTIAL SQ.FT:
0
COMMERCIAL SQ FT:
0
INDUSTRIAL SQ FT: 0
GARAGE SQ IT:
0
OFFICE SQ FT:
0
WAREHOUSE SQ FT: 0
ROOF SQ FT:
0
TENANT IMPR SQ FT:
0
OTHER SQ. FT: 0
NUMBER OF UNITS:
1
NUMBER OF STORIES'
0
CBC EDITION: 2016
NUMBER OF SEATS:
0
VALUATION...:
$0.00
BUILDER VALUATION: $0.00
FEE SUMMARY
PLAN CHECK
$0.00
BUILDING PERMIT:
$35.00 PLN INSP.:
MECH PERMIT:
$0.00
PLUMBING PERMIT:
$44.39 ELEC PERMIT:
SIGN PERMIT:
$0.00
GRADING PERMIT:
$0.00 PRIVATE IMPR
NEW DEV. TAX:
$0.00
TSIP ZONE A FEE:
$0.00 TSIP ZONE B FEE:
SMIP FEE:
$0.50
MICROFILM FEE:
$5.40 OCFA FEE:
PENALTY FEE.:
$0.00
REFUNDABLE BOND:
$0.00 MISCELLANEOUS:
PLN REVIEW:
$0.00
TOTAL FEES:
$121.18
LICENSED CONTRACTOR DECLARATION
"iffflIF
FEB 2 3 2017
CITY OF TUSTIPi
CASHIER
$0.00
$35.89
$0.00
$0.00
$0.00
$0.00
I hereby affirm that I am a licensed Contractor under the provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code, and my license
LICENSE NUMBER: 874670 LICENSE CLASS: B
Expires DATE:03/31/2018
OWNER BUILDER DEC.) ARATION:
I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business Professions Code: Any City or county which requires a perm
structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License L:
3 of the Business & Professions code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant'for a permit su
hundred dollars (S500-00)-
1 as owner of the property, or my employees withwages as thein sole compensation, will do the work and the stmcturc is not intended or offered for sale (Section 7044, Busi
not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvemem
building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purposes of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business & Professions Coda The Contractor's Lice
or improves Theron, and who contracts for such projects witha contractor(s) license pursuant to the Contractor's License Law).
I der Section Business & Professions Code for the following mason(s):
Owner Si tore: Date:
WORKERS' 'OMI'ENSATJON DECLARATION:
I hereby of rou under penalty of perjury one of the following declarations:
I have and will maintain a certificate of concent to self -insure for Workefs Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the w(
I have and will maintain Worker's Compensation insurance, ac required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
Number we,
POLICY NUMBER: 1.846083 COMPANY: STATE FUND
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the erformance of the rk whicy this permit is issued, I shall not employ any person in any maturer so as to become subject to the Worker's Compensal
subject to [hc�7oikerIrgpylfsatio� r .. ro f � 'on1700 of the Labor Code, I shall forthwith comply with those provisions.
WARNING: FaiWn to secure Worker's Compensation coverage is unlawfid, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ('
as provided for in Section (3 700) of the Labor Code, interest and attorney fees.
IMPORTANT:
Application is hereby nude to the Building Official for a permit subject to the conditions and restrictions set forthon this application. Each person upon whose behalf this applicatir
benefit work is performed under or pursuant to any permit issues as a result of this application agrees to, and shall, indemnify and hold harriless the City of Tustin, its officers, agen
Chapter 2 of the Uniform Administrative Code. I agree not to occupy or allow occupancy of any building authorized by this permit until foal inspection has been received. I certify
information is correct. I agree to comply with all City and State laws relating to the building construction, and hereby authorize representative of the City to enter upon the above m
1"
-**BUII,DING PERMITS ARE SUBJECT TO EXPIRATION IF WORK IS NOT COMMENCED -WITHIN 180 DAYS AFTER DATE
OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS'*-
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